自閉症類群障礙兒童問題行為與母親因應策略對母親憂鬱和生活品質之影響

The Effect of Problem Behaviors of Children with Autism Spectrum Disorder and Coping Strategies of Mothers on Their Depression and Quality of Life

邱怡婷(Yi-Ting Chiu)

指導教授 ： 吳進欽

高雄醫學大學/人文社會科學院/心理學系碩士班/碩士(2018年)

摘要

研究目的：自閉症類群障礙症（autism spectrum disorder, ASD）兒童的家長，生活品質與心理健康較差，影響家庭功能和教養行為。雙重ABCX模型經常被用來解釋ASD家庭的適應結果，探究壓力源、社會支持、認知評估，及因應策略，對家長心理健康及生活品質的影響。過去少有研究針對學齡前ASD兒童的母親，探究面對壓力的因應策略及其適應結果。本研究針對台灣樣本，以5歲以下ASD兒童母親為對象，根據雙重ABCX架構探究因應策略與適應結果的關係。
研究方法：受試者為112名ASD兒童母親，母親平均年齡34.73歲，兒童平均年齡33.96個月。以兒童行為檢核表（Child Behavior Checklist for age 1.5-5, CBCL/1.5-5）測量兒童的問題行為；簡明因應量表（Brief COPE, B-COPE）的認知再建構與親職壓力量表（Parenting Stress Index, PSI）的社會孤立，分別作為母親認知評估與社會支持的指標；貝克憂鬱量表第二版中文版（Beck Depression Inventory-Second Edition, BDI-Ⅱ）及台灣簡明版生活品質量表（World Health Organization Quality of Life-BREF, WHOQOL-BREF）分別測量母親的憂鬱情緒及生活品質。此外，將B-COPE的問題焦點因應及逃避因應納入模型，探究因應策略與適應結果之關係。
研究結果：（1）模型一，納入問題行為、問題焦點因應、社會孤立，及認知再建構，解釋母親憂鬱，得到接近適配的結果。（2）模型二，納入問題行為、逃避因應、社會孤立，及認知再建構，解釋母親憂鬱，模型適配度不佳。（3）模型三，納入問題行為、問題焦點因應、社會孤立，及認知再建構，解釋母親生活品質，得到接近適配的結果。（4）模型四，納入問題行為、逃避因應、社會孤立，及認知再建構，解釋母親生活品質，模型適配度不佳。
研究結論：本研究結果發現問題焦點因應能提升ASD兒童母親之生活品質，在模型中能解釋母親之適應結果。逃避因應則對母親的心理健康及生活品質有害，但在模型中未能有效解釋母親之適應結果。本研究結果可作為臨床工作者，改善ASD兒童母親適應結果之參考。

關鍵字

自閉症類群障礙症 ； 雙重ABCX模型 ； 因應策略 ； 適應結果

並列摘要

Background and objectives: Parents of children with autism spectrum disorder (ASD)　experienced higher levels of depression and lower levels of quality of life, then interfered with family functioning and parenting behavior. The double ABCX model of family adaptation was used to explore the impact of stressors, social support, cognitive appraisal, and coping stratigies on parental mental health and quality of life. There are few studies investigated the coping strategies for comfronting stressors and the following adaptive outcomes in mothers of preschool children with ASD. The present study focused on Taiwanese mothers of preschool children with ASD under aged 5. According to double ABCX model, we developed four models to investigate the relationship between coping strategies and adaptative outcomes.
Method: 112 mothers of children with ASD were recruited in this study. The average ages of mothers and children were 34.73 years old and 33.96 months old, respectively. The Child Behavior Checklist (CBCL) was used for measuring the children behavior problems and the Brief Coping Orientations to Problems Experienced Scale (B-COPE) was used for measuring maternal coping strategies and cognitive appraisal. The Parenting Stress Index (PSI) was used for measuring the maternal social support. In addition, the Beck Depression Inventory-Second Edition (BDI-Ⅱ) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) were used for measuring the depressed mood and the quality of life of mothers. The models included pfoblem-focused coping and avoidant coping separately to explore the relationship between coping strategies and adaptive outcomes.
Results: (1) Model 1, testing the relationship between problem behavior, problem-focused coping, social isolation, cognitive reframing, and depression, was close to a good fit. (2) Model 2, testing the relationship between problem behavior, avoidant coping, social isolation, cognitive reframing, and depression, wasn’t found to be a good fit. (3) Model 3, testing the relationship between problem behavior, problem-focused coping, social isolation, cognitive reframing, and quality of life, was close to a good fit. (4) Model 4, testing the relationship between problem behavior, avoidant coping, social isolation, cognitive reframing, and quality of life, wasn’t found to be a good fit.
Conclusion: This study found that using problem-focused coping strategy can improve the maternal quality of life in mothers of preschool children with ASD. The two models that included problem-focused coping were close to good fits to explain maternal adaptive outcomes. Using avodiant coping strategy might be harmful for both mental health and quality of life. However, the two models which included avoidant coping were not good fits to explain maternal adaptive outcomes. The results of this study provide implications for clinical practitioners to improve the adaptive outcomes of mothers who raise young children with ASD.

並列關鍵字

autism spectrum disorder ； double ABCX model ； coping strategy ； adaptive outcome

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